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目的 比较单支与多支血管病变急性心肌梗死 (AMI)患者直接经皮冠状动脉介入 (PCI)后远期心功能和心脏事件的发生率。方法 115例AMI患者 ,均于发病后 12h内直接行PCI和支架术。根据急诊冠状动脉造影结果将患者分为单支血管病变组 (单支血管组 ) 6 6例和多支血管病变组 (多支血管组 ) 4 9例。询问有无梗死前心绞痛史 ,发病后 10d及 9个月行二维心动超声检查 ,随访时记录心脏事件。结果 单支血管组 12例出现梗死前心绞痛 ,多支血管组为 18例 ,两组间差异有显著性 (P <0 .0 1) ;单支血管组PCI后平均左心射血分数(LVEF)为 5 3.0 0 %± 6 .76 % ,多支血管组为 5 2 .18%± 8.5 2 % ;随访时单支血管组平均LVEF为 5 9.10 %±3.2 3% ,多支血管组为 5 8.0 1%± 7.88% ,两组间差异均无显著性 (P值均 >0 .0 5 )。随访时单支血管组心力衰竭6例 ,多支血管组 4例 ;单支血管组心绞痛 3例 ,多支血管组 2例 ;单支血管组恶性心律失常 2例 ,多支血管组 3例 ;单支血管组心源性死亡 2例 ,多支血管组 0 ;单支血管组复合终点事件为 13例 ,多支血管组 9例 ,两组间差异均无显著性 (P值均 >0 .0 5 )。结论 无论单支或多支血管病变 ,对AMI后梗死相关动脉行直接PCI均同样有效。
Objective To compare the long-term cardiac function and cardiac events after direct percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) of single vessel and multivessel disease. Methods One hundred and fifteen patients with AMI were directly treated with PCI and stenting within 12 hours after their onset. According to the results of emergency coronary angiography, 66 patients were divided into single vessel disease group (single vessel group) and multivessel disease group (multiple vessel group), 49 patients. Ask whether there is a history of angina before infarction, 10d and 9 months after onset of two-dimensional echocardiography, follow-up record of cardiac events. Results The incidence of pre-infarction angina was found in 12 cases of single-vessel group and 18 cases of multiple-vessel group, with significant difference between the two groups (P <0.01). The average left ventricular ejection fraction (LVEF) ) Was 53.0% ± 6 .76%, while in the multi-vessel group was 5.218% ± 8.52%. The mean LVEF in the single vessel group was 5 9.10% ± 3.2 3% and the multi-vessel group was 5 8.0 1% ± 7.88%. There was no significant difference between the two groups (P> 0.05). At follow-up, there were 6 cases of single-vessel heart failure, 4 cases of multi-vessel group, 3 cases of single-vessel angina pectoris, 2 cases of multiple vessel group, 2 cases of single-vessel malignant arrhythmia and 3 cases of multiple vessel group. Cardiac death in single vessel group was found in 2 cases and multi - vessel group was 0. Group A was found in 13 cases in single vessel group and in 9 cases in multiple vessel group. There was no significant difference between the two groups (P> 0). 0 5). Conclusions Regardless of single or multiple vessel disease, direct PCI of the infarct-related artery after AMI is equally effective.